Multidisciplinary Heart Failure Clinics Are Associated With Lower Heart Failure Hospitalization and Mortality: Systematic Review and Meta-analysis
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BACKGROUND: Heart failure (HF) clinics (HFCs) are an integral aspect of the strategy for community HF care. METHODS: A systematic search was conducted to retrieve studies. We searched for candidate articles in the PubMed, EMBASE, and Cochrane databases from 1990 to January 2017. RESULTS: We included 16 randomized controlled trials in the meta-analysis with 3999 patients. The HFC group had a lower incidence of the primary composite end point of HF hospitalization and all-cause mortality (odds ratio [OR], 0.58; P = 0.0003). The benefit was maintained when stratified according to non-nurse led HFCs (OR, 0.52; P = 0.003), clinics that followed-up patients ≥ 3 months (OR, 0.51; P = 0.0009), patients with mean ejection fraction ≤ 30% (OR, 0.39; P = 0.02), and ejection fraction > 30% (OR, 0.72; P = 0.02), and patients with recent hospitalization for HF (OR, 0.51; P = 0.0001). There was no benefit in patients who were seen in HFCs with limited follow-up ≤ 3 months (OR, 0.91; P = 0.69), patients with stable HF without recent hospitalization (OR, 0.95; P = 0.70), and studies published after 2008 (OR, 0.89; P = 0.31). Patients in the HFC group had lower HF hospitalization rates (OR, 0.68; P = 0.003), however, no significant difference in all-cause hospitalization (OR, 1.04; P = 0.33). There was lower all-cause mortality in the HFC group (OR, 0.71; P = 0.006). CONCLUSIONS: The results of our analysis show a benefit of HFC to reduce HF hospitalization, and all-cause mortality. This was a cumulative benefit of all randomized clinical trials that assessed the benefit of HFC, with additional analysis showing a greater benefit among patients with recent emergency room visit or hospitalization, and patients seen frequently in follow-up ≥ 3 months.
